Mental Health Survey
Your age *
Gender *
Tell me about your sleeping habits over the past months. Have you noticed any changes? Difficulty sleeping? Restlessness? *
Do you ever feel that you’ve been affected by feelings of edginess, anxiety, or nerves? *
Have you experienced a week or longer of lower-than-usual interest in activities that you usually enjoy? Examples might include work, exercise, or hobbies. *
Have you ever experienced an ‘attack’ of fear, anxiety, or panic? *
Do feelings of anxiety or discomfort around others bother you? *
How frequently have you been bothered by not being able to stop worrying? ( in months ) *
How often over the past few weeks have you felt the future was bleak? *
Let’s discuss how you have been feeling about your relationships recently. *
Have you been doing things that mean something to you or your life? *
How has been your appetite recently ? *
How do I feel most of the time? *
What are your energy levels like when I finish my day?
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Having mood swings ?
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Any suicidal thoughts, breakdowns, or panic attacks?
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